DESCRIPTION: Over the past three decades, two demographic shifts have markedly changed the situation faced by sick children. First, more children live in single parent homes. In 1979, 13 percent of families with children under 18 years old were headed by one parent. By 1993, that number had risen to 28 percent of families. Second, the number of children living in families in which all parents are in the labor force has grown dramatically. The percentage of mothers of preschool children who work for pay has risen almost five fold over 45 years from 12 percent in 1947 to 58 percent in 1992. The percentage of mothers of school-age children who work for pay has almost tripled over the same period of time from 27.3 percent to 75.9 percent. While the percentage of mothers working has risen sharply, the percentage of fathers working has not fallen. Over 95 percent of married men aged 20-44 are in the labor force. These demographic shifts, which have resulted in fewer parents being at home, are likely to affect the care of sick children. Despite the widespread recognition by 46 state governments and private employers of a potential conflict between parents' needs to care for sick children and to work for pay, we know little about the effect of changes in parental employment, work conditions, family structure and support on the preventive, sick day, and curative medical care children receive. The goal of this project is to use a social ecological theoretical framework to examine how family structure and parental work affect the care of sick children. The specific aims of the proposed research are to: 1. Determine how family structure and parental employment affect the extent and timing of children's preventive medical care, specifically prenatal care, childhood vaccinations and well child care visits; 2. Analyze whether family structure and parental employment characteristics affect the setting of curative care; 3. Determine who cares for children when they are sick and how that care varies by family structure and parental employment. 4. Measure the extent of work absences among parents caring for sick children, and analyze how work absences depend on family structure, support and job conditions. Multivariate regression will be conducted on six large national and three regional data sets. Two of the data sets contain longitudinal data and six provide new data collected for this project.